I have put this misinformation ‘into the public domain without proper fact checking’;

I have a ‘tendency to inflate and take liberty with the facts’.

Ms Beaumont has also sent me a letter, which lays out her views in greater detail.

It is disappointing that in launching what amounts to a public attack on my reputation, Women’s Health Victoria has itself put out information containing serious omissions and inaccuracies. These give a misleading impression concerning both the abortion law in Victoria, and statistics for late-term abortions.

1. The Abortion Law Reform Act 2008

One of the claimed inaccuracies concerned a report, published in the Melbourne Age on 7th October 2010, that I had claimed conscientious objection by medical staff was now illegal in Victoria. This comment was reported in the context of the employment of hospital medical staff.

Ms Beaumont alleges that this is inaccurate, on the grounds that:

Section 8 of the Abortion Law Reform Act allows health practitioners to object to abortion.

However a health professional who has a conscientious objection to abortion is required to refer a woman for termination of pregnancy services.

Any conscientious objection to making such a referral ‘does not have merit’.

The Act’s rejection of conscientious objection in relation to referral is ethically correct, because in the context of referral, a woman’s right to make informed choices about her health must take precedence over the conscience of the health practitioner.

In response to this argument, I note first that Ms Beaumont has correctly conceded that it is illegal in the state of Victoria for a health practitioner to object, on grounds of conscience, to referring a woman for abortion services. In this respect, conscientious objection by health practitioners is illegal in Victoria. Ms Beaumont appears to regard this illegality as trivial – she maintains such an objection ‘does not have merit’ – however this value judgment relies upon a contentious ethical opinion about the moral value of abortion, which regards it simply as a decision made by a woman about her own body.

Second, and more importantly, the Section 8 concession to conscientious objection only applies in the case when a woman has requested a health practitioner to advise or treat her in relation to abortion. No such concession exists in the case of hospital staff – such as operating theatre workers – who do not have a direct relationship with the woman. In this context Section 8 is irrelevant, and conscientious objection by health practitioners receives no protection under the Abortion Reform Act 2008.

The comments attributed to me in the Melbourne Age were specifically in relation to hospital health workers. It is therefore disappointing that Ms Beaumont has misrepresented the scope and application of the Abortion Law Reform Act. Nothing in the WHV press release acknowledges that Section 8 of the Act does not apply to hospital health practitioners who have no direct relationship with the patient. This was a significant omission.

2. Government Statistics for Abortion in Victoria

Ms Beaumont stated that “A significant proportion of late-term abortions, including the 52 mentioned in this article, [i.e. in The Melbourne Age, 7th October 2010] are for congenital abnormality.” Based on this observation, she alleges that:

“The minister’s [i.e. Mark Durie’s] comments are not only inaccurate but grossly insensitive both to the health care providers and families involved in late-term abortions for congenital abnormality and the impact this can have.”

The rebuke appears to rely on an implication that late-term abortions in Victoria are primarily for congenital abnormality. This is not true. For example in 2005 there were 129 late-term abortions reported in Victoria for reasons of congenital abnormality, but 180 for ‘psychosocial indications’ (i.e. there was nothing wrong with the baby). The proportion between abortions for congenital abnormalities and psychosocial indications depends upon how late in the pregnancy the abortion takes place, as the following tables show:

It seems reasonable to speculate that the later a baby is aborted, the more likely it will be for psychosocial indications.

The most stable category of late-term abortions is congenital abnormality at 23+ weeks. Presumably this is because testing for congenital abnormalities keeps on getting better, and the resulting abortions are happening earlier as a result.

Victoria has seen explosive growth in late-term abortions for psychosocial indications. This trend was well underway before the Abortion Law Reform Act in 2008, and there has been an indication that it may be continuing.

A Channel 7 news report, aired on 17 April 2010, reported that late-term abortions at the Royal Women’s hospital had allegedly increased six-fold since the Abortion Law Reform Act 2008 was introduced. This has to be considered on top of the previous 400% state wide increase in late-term abortions for psychosocial indications from 2001-2007. While it is impossible to be sure of figures without further information, the combined multiplicative effect of two such reported increases could be an overall 2400% increase in late-term abortions for psychosocial indications within a ten year period. Such a possibility caused me to move that the Melbourne Synod of the Anglican Diocese request a report from the Victorian State Government about the impact of its liberalization of abortion laws. (See my previous blog post).

The Abortion Law Reform Act went into force in late October 2008, so the full impact of Victoria’s liberalization of abortion laws on late-term abortion statistics will only be publicly known when the 2009 report of the Consultative Council on Obstetric and Paediatric Mortality and Morbidity is released. This will presumably be sometime in late 2011 to early 2012. (The 2008 report has not yet been released as of October 2010, and the 2007 report was only released in April 2010).

I deplore the serious omissions and misleading information concerning the application of abortion law which were contained in the Women’s Health Victoria press release.

I repeat my call for the Victorian Government to report to the public on the impact of Abortion Law Reform, and specifically its impact on the frequency of late term abortions in Victoria. I remain deeply concerned about the implications of what appears to be explosive recent growth in late term abortions in Victoria, including the obvious potential of such growth to impact the recruitment and morale of health practitioners in those hospitals which perform late-term abortions.

Last Saturday I had prepared a motion to bring before the Anglican Synod of the Diocese of Melbourne. Unfortunately it was not possible to present the motion. Here is the motion, and an edited version of the speech which I had prepared to present.

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The Motion

That this Synod,

a reported six-fold increase in late-term abortions being performed at the Royal Women's Hospital since the introduction of the Abortion Law Reform Bill in October 2008;[1] and

a reported 52 cases in 2007 of late-term abortions (15% of the total in that year) which resulted in babies being born alive;

calls upon the State Government of Victoria to investigate and report to the people of Victoria on the following matters:

How many late-term abortions are being performed in Victoria every week, and at how many weeks gestation?

What are the reasons these abortions are being performed, and in what proportions?

For those babies born alive as a result of a late-term abortion, were the neonates given the medical care at birth which a new born infant would normally be entitled to, and what was their cause of death?

What has been the effect on staff morale of the reported six-fold increase in late-term abortions being performed at the Royal Women's Hospital?

What impact has the reported increase in late-term abortions had on policies for recruitment of staff at the Royal Women's Hospital?

Abortion is a vexed ethical subject. For women who make the choice to have an abortion, it can be one of he most difficult and painful decisions of their lives.

As with all challenging ethical areas of medicine, it is important for the community to be well-informed. This motion is not intended to incite tensions or cause anyone pain. Rather it is a request that the community be informed about what is happening in regard to late-term abortions in this state.

In 2008 the Victorian State Parliament passed an Abortion Law Reform Bill which decriminalized abortion in Victoria. One of the intentions of the reform, according to the Attorney-General, was that current clinical practice in the provision of abortions not be altered. The Attorney-General also stated that the intention in reforming the law was not to lead to more abortions being performed.

However, evidence has emerged that there has been an increase in the numbers of late-term abortions, and this is affecting the practice of abortion provision in Victoria.

A Channel 7 news report, broadcast on 17 April 2010 reported that there had been a six-fold increase in late-term abortions being performed at the Royal Women’s Hospital since the introduction of the 2008 Abortion Law Reform. Presenter Jennifer Keyte said “midwives and doctors feel traumatized” by having to perform so many late-term abortions at the Royal Women’s, and were unhappy that other hospitals were refusing to perform them. Journalist Louise Milligan said that there had been some ‘alarming requests’ for late-term abortions, including, for example, a request for a termination at 32 weeks because the baby had a hare lip

Earlier this year the Consultative Council on Obstetric and Pediatric Mortality and Morbidity published its annual report for 2007, which included a survey of perinatal and neonatal deaths. This report states that in 52 cases terminations of pregnancy due to congenital abnormality resulted in a live birth. In other words the baby died after birth.

It is important that we be sensitive about these tragic situations, and to acknowledge that in many such cases the abnormalities themselves, rather than the abortion, would have been the cause of death of the infant. It can be vitally important to grieving families to hold their live baby before it dies.

This same report reveals that from 2001 to 2007 the number of late-term abortions performed in Victoria for psychosocial reasons – i.e. there was no congenital abnormality – increased from 45 yo 164, an almost four-fold increase. The increase was greater at later stages of pregnancy: in every year from 2002-2007 psychosocial abortions from 23 weeks on took place twice as often (and in some years more than four times as often) as abortions for congenital abnormalities. Some of these late-term psychosocial terminations even took place after 28 weeks.

All this was well before the 2008 liberalization of abortion laws, and the reported six-fold increase in late-term abortions at the Royal Women’s Hospital.

My point in citing these figures is that late terminations of pregnancies appear to have been increasing in number in this state for quite some time. This is a serious matter, which deserves careful consideration. The public needs to be informed about what is happening, and particularly about the impact of the 2008 Abortion law reform, which was intended – according to the Attorney General – to result in no increase in the frequency of abortions.

Some newborns survive an abortion. Gianna Jessen is one such person, who has visited Victoria in the past to speak about her experience. As the numbers of late terminations seems to be increasing, with more and more abortions of viable babies, it is important that the public be informed about what happens in those cases when the baby is actually born alive.

To help show that the problem of late-term abortions resulting in a life birth is not a figment of the imagination, I note that in 2005 the Sunday Times reported a UK Government investigation to consider reports that late-term abortions in the UK were resulting in as many as 50 live-births a year. These cases were not because of congenital abnormalities – the situation already discussed – but because the baby was viable, yet its life had not been terminated before being delivered. I stress however that this was the UK, not Victoria.

Any increase in late-term abortions raises difficult ethical challenges for those hospitals which perform them. It is reasonable to ask, not only for what reasons they are being performed, but what affect does this have on staff recruitment and retention? This relates to the issue of conscientious objection. There is a conscientious objection provision in the Abortion Law Reform Act 2008 for a health practitioner who has been requested by a woman to advise or treat in relation to abortion. However no such provision exists in the case of medical staff – doctors and nurses – who are working in operating theatres in hospitals and have no direct relationship with the women.

The Department of Human Services has written to the Australian Nursing Federation to say that, if a staff member has a conscientious objection based upon religious conviction, there is a provision in Equal Opportunity Legislation that employers are legally obliged to respect such beliefs. However not all conscientious objectors will be working from religious conviction. Indeed it would seem unfair to discriminate against those whose conscientious objection is not faith-based.

The ANF itself has guidelines designed to protect the right of nurses to conscientiously object to procedures and practices to which their conscience is opposed. However, it must be problematic, in a context of increasing numbers of late-term abortions, for a hospital to exempt some staff from participating in certain types of late term abortions, as this will increase the load upon the staff who are willing. Indeed health professionals at the Royal Women’s have reportedly complained about being asked to shoulder a growing burden of these procedures.

Such dynamics must surely also put pressure on the hospital to select staff on the basis of their willingness to participate in late-term abortions. These operations are disliked by many, and the more staff there are who can be exempted, the harder it will be for everyone else.

Fellow members of Synod, these are very painful and difficult issues. But this does not mean we should shy away from them. This motion is a request for information. It does not accuse or condemn. In a context of changing practice, in which late-term abortions are apparently becoming more frequent, it asks that we be fully informed about the impact of this change, including as it relates to the care of the new born, and to the morale and recruitment of medical staff.

Over the past few days I have received moving accounts of the emotional and moral complexities of late-term abortions. There are shades of grey, as one writer said. This motion is a request for light to be shone onto this difficult but highly important ethical issue, out of concern that, for lack of scrutiny, late term abortions have for us in Victoria become very black indeed.